MR spectroscopy (case1). MR spectroscopy of the vermis before (upper trace) and 10 months after (lower trace) the introduction of mycophenolate. Patient already on gluten free diet for several years but with refractory coeliac disease (type 2). The NAA peak significantly increased as did the NAA/Cr (from 0.68 to 0.96). This was associated with clinical improvement of the ataxia.